Qualitative Study of Attitudes of Healthcare Professionals Regarding Accreditation and Quality, in the Pre-accreditation Period in R. Macedonia

  • A. Petrusevska Aneta Petrusevska, MD, dermatovenerologist, Clinic Dr. Ancevski; PhD student at the University “Ss. Cyril and Methodius” in Skopje, Macedonia.
  • V. Dimitrievska Vera Dimitrievska, Phd, University of Groningen.
  • E. Zisovska Elizabeta Zisovska, MD, PhD., professor, Agency for Quality and Accreditation of Healthcare Organizations in R. Macedonia.
  • M. Spasovski Mome Spasovski, MD, PhD, professor, Institute of Social Medicine, Medical Faculty, University of “Ss Cyril and Methodius, Macedonia.
Keywords: pre-accreditation period, accreditation, quality, perceptions of healthcare professionals.


 A total of 30 themes emerged during the coding and were grouped in 6 main domains - Institutional, organizational and management settings; Financial issues; Education; Normative regulations; Professionalism,Quality of care and services-which  jointly gave an insight to the perception about  accreditation of health care organizations in Macedonia on a tertiary level. We can conclude that the healthcare providers in our study perceive accreditation as a tool, which can catalyze the process towards improving the overall performances in a healthcare organization towards achieving the end goal to deliver  quality services to the patients.The healthcare system in the Republic of Macedonia has planned to commence  accreditation of  the healthcare organizations. The Government of  Macedonia chose to  establish its own hospital accreditation systems. The objective of this study is to understand the attitudes of healthcare professionals in hospitals in Macedonia, to gain  understanding of the value of accreditation on quality of care as perceived by the staff members and  the possible strategies to improve implementation of accreditation , in a pre-accreditation period in R. Macedonia. We chose a qualitative research method and  study  explorative in nature to see the perceptions and opinions of providers. We used purposive sampling and included  health care providers from tertiary health care level. Semi-structured interviews with open questions were used as research tools.


[1]. World Health Organization: Quality improvement in primary health care: a practical guide. Geneva, Switzerland: WHO; 2004.
[2]. World Health Organization: The World Health Report. Primary healthcare: now more than ever. Geneva, Switzerland: WHO; 2008.
[3]. Klazinga N., 2000. “Re-engineering trust: the adoption and adaption of four models for external quality assurance of health care services in western European health care systems”. Int J Qual Health Care: 2000;12:183-9
[4]. Montagu D. 2003. “Accreditation and other external quality assessment systems for healthcare: Review of experience and lessons learned. London: Department for International Development Health Systems Resource Centre”; retreived from http://www.dfidhealthrc.org/publications/health_service_delivery/Accreditation.pdf.
[5]. Braithwaite, J., Westbrook, J., Pawsey, M., Greenfield, D., Naylor, J., Iedema, R.,Gibberd, R. 2006.” A prospective,multi-method, multi-disciplinary, multi-level, collaborative, social-organizational design for researching health sector accreditation”. BMC Health Services Research 2006, 6:113 doi:10.1186/1472-6963-6-113
[6]. Petrusevska A., Kjosevska E., Isjanovska R., Zafirova B.,Spasovski M., Zisovska E., 2015. “Evaluating Perceptions of the Healthcare Providers Concerning Accreditation Healthcare Organizations in the R. Macedonia”. Journal of US-China Public Administration. Volume 12, Number 6, (Serial Number 116)485-497
[7]. Davitkovski B i sor. Pravo i Javno Zdravstvo - Skopje : Praven Fakultet”Justinijan Prvi”, 2009 ISBN 978-9989– 194-37-5: 54-57
[8]. Bender K, Halverson PK.” Quality Improvement and Accreditation: What Might It Look Like?” Public Health Manag Pract. 2010 Jan-Feb;16(1):79-82. doi: 10.1097/PHH.0b013e3181c2c7b8
[9]. Glouberman S, Mintzberg H, 2001 “Managing the Care of Health and the Cure of Disease - Part II Integration 1998/50/SM-Health care management review, journals. retreived from http://journals.lww.com/hcmrjournal/Abstract/2001/01000/ Managing_the_Care_of_Health_and_the_Cure_of.6.aspx
[10]. Cline B.G., LuizM.J. 2013.” Information technology systems in public sector health facilities in developing countries: the case of South Africa”. BMC Med Inform Decis Mak. 13: 67.
[11]. Simon R.S, Keohane A.C., Amato M., Coffey M, Cadet B., Zimlichman E., and Bates W.B., 2013, “Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study “. BMC Med Inform Decis Mak. 13: 67.
[12]. Pullon S., Dew K., 2008.” Primary health care in New Zealand: the impact of organizational factors on teamwork”. Br J Gen Pract. 2009 Mar 1; 59(560): 191–197.
[13]. Laker C., Callard F., Flach C., Williams P., Sayer J., Wykes T., “The challenge of change in acute mental health services: measuring staff perceptions of barriers to change and their relationship to job status and satisfaction using a new measure (VOCALISE)” Implement Sci..
[14]. Franx G., Oud M., e de Lange J., Wensing M., Grol R., 2012. „Implementing a stepped-care approach in primary care: results of a qualitative study” Implement Sci.
[15]. Vanthuyne K., Meloni F., Ruiz-Casares M., Rousseau C., Ricard-Guay A. 2013. “Health workers' perceptions of access to care for children and pregnant women with precarious immigration status: Health as a right or a privilege?”. Social Science & Medicine Vol. 93, Pages 78–85
[16]. Suñol R., Nicklin W., Bruneau C., Whittaker S.” Promoting research into healthcare accreditation/external evaluation: advancing an ISQua initiative: retrieved from : DOI: http://dx.doi.org/10.1093/intqhc/mzn045 27-28 First published online: 3 October 2008
[17]. Institute for Accreditation of R. Macedonia. Retrieved from https://www.iarm.gov.mk
[18]. Huang, P., Hsu, Y.-H. E., Kai-Yuan, T., & Hsueh, Y.-S. 2000.” Can European external peer review techniques be introduced and adopted into Taiwan’s hospital accreditation system?” International Journal for Quality in Health Care, 12(3), 251-254.
[19]. M. Hennink, I. Hutter & A. Bailey 2011, Qualitative Research Methods, Sage Publications
[20]. Flick, U. 2009, ‘’An Introduction to Qualitative research’’, Fourth Edition, Sage Publications
[21]. Hyden, M., 2008. Narrative sensitive topics In: M. Andrews, C. Squire, & M. Tamboukou, (Eds.). Doing narrative research. London: Sage
[22]. Dhai, A.,2008 2008, What does professionalism in health care mean in the 21st century? : editorial, South African Journal of Bioethics and Law, Vol. Issue 1.
[23]. Andruszkow, H., Hildebrand, F., Horst, K., Christoph-Pape, H. 2014. Professionalism in Health Care. Chapter, Patient Safety in Surgery. pp 123-128.